Treatment depends largely on the location, type, severity, and cause of the varicose veins. There are both invasive and noninvasive treatments available. Most involve a combination of therapies. In cases in which the varicose veins return, invasive therapies are usually applied.

Noninvasive Treatments

Noninvasive treatments include:

• Lifestyle modification
• Compression therapy

Lifestyle Modification
Lifestyle modifications are the same activities recommended for preventing varicose vein development. Regardless of how severe any additional treatments may be, life modification is essential for a full recovery from treatment. Losing weight and exercising can help improve outcomes by staving off the obesity risk and by improving calf pump function. Elevating the feet and alternating between sitting and standing also reduce the compression of the veins in the lower limbs.

Compression Therapy
Compression therapy is the first line treatment of varicose vein related discomfort and swelling. This treatment is particularly recommended for individuals with large and more severe varicose veins. Treatment involves wearing compression stockings over the affected areas. The stockings are put on in the morning while sitting or lying down, worn all day, and then removed before bed. The stockings reduce venous reflux and venous hypertension while walking.  Different levels of compression are applied based on the severity of the symptoms and varicosity. The effects of this treatment on varicose vein recurrence and progression are not completely clear.  Unfortunately, a majority of patients prescribed compression stockings do not wear them as prescribed. Many subpopulations of patients may have difficulty with this treatment as well, such as the obese and elderly. There are however devices designed to aid in donning the stocking, that is available.

Invasive Treatments
Invasive procedures include:

• Microincision phlebectomy
• Vein stripping and ligation
• Local ablative therapy
• Endovenous therapy (Radiofrequency ablation)
• Foam sclerotherapy

Microincision phlebectomy
Microincision phlebectomy, also known as stab or ambulatory phlebectomy, is a minor procedure involving the removal of varicose veins and side branches through a small opening. The procedure can be done outpatient under local anesthesia. It typically takes 1-2 hours and requires little recovery time. The small incision ensures minimal scarring. This treatment is best for superficial veins.

Vein and stripping and ligation
Varicose vein stripping is the removal of large varicose veins through a large incision. Two to three incisions are made, and a wire is threaded through one incision into the vein. The wire is tied to the vein and then pulled out through another incision. Vein ligation is the tying off of a section of a vein with damaged valves through an incision. This allows the vein to continue to move blood between other healthier valves. The procedure is primarily done for large varicose veins in the greater and lesser saphenous veins, and to prevent the development of ulcers following treatment. It may also be done for cosmetic reasons, to reduce swelling, aching and heavy feelings while standing, to treat varicose vein bleeding or open sores, or if the vein is one that feeds into the superficial and deep veins of the knee and groin. The procedure is relatively minor and can be done under general or local anesthetics. It should not be performed on older adults with other medical conditions, individuals with poor circulation in the arteries of the lower extremities, pregnant women, or individuals with an abnormal link between the veins and arteries of the leg. The treatment is effective in approximately 80% of people. However, there are many risks involved compared to other available options such as endovenous therapy. Nearly half of patients experience a recurrence within 5 years of vein stripping due to incomplete vein removal, persistent venous reflux or the development of new vasculature. Other risks include:

• Ecchymosis (discolored skin resulting from bleeding under the skin)
• Scarring
• Subcutaneous bleeding
• Hematoma (collection of blood outside the blood vessels)
• Lymphocele (collection of lymphatic fluid)
• Infection
• Nerve injury
• Deep vein thrombosis

Endovenous therapy
Endovenous laser therapy (EVLT) is becoming an increasingly popular alternative to vein stripping and ligation. Endovenous laser therapy is also a minimally invasive procedure. The procedure involves applying a small amount of local swelling anesthesia to the area to separate the skin from the vein and to protect surrounding skin from injury. A laser probe is then inserted through a needle placed in the vein.  The probe is then moved through the vein by the doctor using ultrasound imaging in order to identify problem areas to be targeted by the laser. The laser is then fired along the wall of the vein to damage it. The thermal injury causes clotting and excess tissue formation to close off the vein. Blood entering that vein will be redirected to healthy veins. The probe is then removed. Alternatively, radio frequencies can be used instead of lasers.

Advantages of this procedure include:

• Can be performed, outpatient
• Provides immediate relief of symptoms
• Little to no recovery time
• No scarring
• 84- 94% success rate

However, there are risks to this procedure such as:

• Numbness
• Pulling sensation
• Phlebitis (vein inflammation)
• Deep vein thrombosis
• Infection
• Skin burns
• Nerve injury

Vein stripping and ligation are preferred to endovenous therapy in cases where the greater saphenous vein is too contorted, close to the skin or enlarged through a weakening of the wall.

Foam sclerotherapy
Foam Sclerotherapy is a burgeoning technique that could potentially be applied to a wide variety of varicose veins. The procedure involves injecting foam sclerosant (a chemical or drug that causes sclerosis or a thickening of the vessel wall to block blood flow) into the targeted vein. The foam is created by combining the drug with a gas in a syringe using mechanical pumps. The foam enhances drug contact with the vein walls. Sclerosant causes the lining of the blood vessel to swell and the blood to clot in order to close the vessel. However, concerns about the foam forming clots have reduced interest in this treatment. The procedure is relatively quick. It can take 15 to 45 minutes. It is also possible to target multiple veins in one session. It is not recommended for pregnant women or individuals with a history of blood clots. Some side effects that may arise are relatively minor. These include itching, bruising, and redness at the injection site. However, more severe side effects are possible, such as the appearance of brown lines and spots at the vein site, the temporary (several months) hardening of larger veins, and development of temporary tiny blood vessels. The treatment has been found to be between 50-80% effective.